Department of Cardiothoracic Surgery Karolinska University Hospital Stockholm Sweden.
Department of Molecular Medicine and Surgery Karolinska Institutet Stockholm Sweden.
J Am Heart Assoc. 2024 Jun 18;13(12):e034354. doi: 10.1161/JAHA.124.034354. Epub 2024 Jun 11.
The internal thoracic artery (ITA) is the most important conduit for coronary artery bypass grafting. Recent evidence suggests that skeletonized ITA harvesting yields long-term outcomes inferior to those of pedicled harvesting. The aim was to investigate the impact of the ITA harvesting method on 10-year mortality and major adverse cardiovascular events.
In this observational cohort study, we identified all patients from the SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) register who underwent isolated coronary artery bypass grafting using at least 1 ITA at Karolinska University Hospital from 2012 to 2021. The main outcome was all-cause mortality, and the secondary outcomes were a combination of myocardial infarction, repeat revascularization, heart failure, and stroke. Outcomes were ascertained using national health data registers and compared between the skeletonized and pedicled groups using weighted flexible parametric survival models. Among 3267 patients, 1657 (51%) underwent pedicled ITA harvesting and 1610 (49%) underwent skeletonized ITA harvesting. The patients' mean age was 66 years, and 15% were women. The weighted all-cause mortality incidence rate in the pedicled versus skeletonized ITA group was 2.6% (95CI, 2.2%-3.0%) versus 2.6% (95% CI, 2.2%-3.1%), respectively (hazard ratio (HR), 1.01 [95% CI, 0.81-1.27]). The weighted major adverse cardiovascular events incidence rate was 7.8% (95% CI, 7.1%-8.6%) versus 7.5% (95% CI, 6.7%-8.4%), respectively (HR, 0.94 [95% CI, 0.82-1.08]).
We found no significant differences in all-cause mortality or major adverse cardiovascular events rates between the 2 ITA harvesting methods.
内乳动脉（ITA）是冠状动脉旁路移植术最重要的血管移植物。最近的证据表明，游离ITA 采集的长期效果不如带蒂采集。本研究旨在探讨ITA 采集方法对 10 年死亡率和主要不良心血管事件的影响。
在这项观察性队列研究中，我们从 SWEDEHEART（瑞典心脏病基于推荐治疗的网络系统增强和发展）登记处中确定了所有在 2012 年至 2021 年间在卡罗林斯卡大学医院接受至少一条 ITA 游离冠状动脉旁路移植术的患者。主要结局是全因死亡率，次要结局是心肌梗死、再次血运重建、心力衰竭和中风的组合。通过国家卫生数据登记处确定结局，并使用加权灵活参数生存模型比较游离组和带蒂组。在 3267 例患者中，1657 例（51%）接受带蒂 ITA 采集，1610 例（49%）接受游离 ITA 采集。患者的平均年龄为 66 岁，15%为女性。带蒂与游离 ITA 组的加权全因死亡率发生率分别为 2.6%（95%CI，2.2%-3.0%）和 2.6%（95%CI，2.2%-3.1%）（风险比（HR），1.01[95%CI，0.81-1.27]）。加权主要不良心血管事件发生率分别为 7.8%（95%CI，7.1%-8.6%）和 7.5%（95%CI，6.7%-8.4%）（HR，0.94[95%CI，0.82-1.08]）。
我们未发现两种 ITA 采集方法在全因死亡率或主要不良心血管事件发生率方面存在显著差异。
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